Module 2: Appraisal fit for revalidation
Appraisal systems are not uniform across the UK. To meet the requirements of revalidation, appraisal systems must be robust.
Quality management (QM) of appraisal systems is essential in order that decisions made at appraisal can be relied upon to inform a revalidation decision. The Quality Management report 2017 produced by the GP section of the Wales deanery is an example of such a system in action.
The Revalidation support team in England (RST) produced a number of documents that suggested quality criteria for the whole appraisal process.
- Strengthening NHS medical appraisal to support revalidation in England
- Assuring the quality of training for medical appraisers
The quality management processes suggested are based under four headings:
- There is unequivocal commitment from the highest levels of the host organisation to deliver a quality assured system of appraisal that is fully integrated with other systems of quality improvement.
- The host organisation has a system for selection of appraisers, and appraiser skills are constantly reviewed and developed.
- The appraisal discussion is challenging and effective; it is informed by valid and verifiable supporting evidence that reflects the breadth of the individual doctor's practice and results in a personal development plan (PDP) prioritising the doctor's development needs for the coming year.
- The supporting systems and infrastructure are effective and ensure that all doctors linked to the host organisation are supported and appraised annually.
Specifically dealing with the "appraiser selection, skills and training” the RST have suggested that:
The process for the selection of appraisers needs to ensure that doctors with the appropriate expertise, skills and commitment are selected for this important role.
The training provided for appraisers should be of a high standard and be commissioned and planned by individuals with the appropriate skills. It should develop the skills needed by appraisers to deliver consistently high quality appraisals that challenge and encourage the development of doctors.
The training should follow a consistent curriculum framework that ensures appraisers:
- Understand the purpose of appraisal and its context in relationship to other structures, for improving the quality of medical practice, both in the local organisation and in the wider NHS
- Have the skills to assess information that is submitted or informs the appraisal process
- Have the skills to enable them to carry out an effective appraisal discussion
- Have the ability to produce consistently high quality appraisal documentation
There should be a system for ongoing development and support for appraisers, which includes an assessment of the individual appraiser’s skills in appraising. The appraiser should have, and use a development plan that addresses his or her ongoing development as an appraiser.
The major themes that were suggested around quality assurance of appraisers themselves were:-
Selection: Getting the right people in post
Training: Ensuring consistency of training to the relevant standards
Development and Support: Ensuring that appraisers can develop in their role
Individual Development: Including external quality control of outputs which examines the appraiser’s skill in respect of:-
- preparing for an appraisal
- the appraisal discussion itself
- recording the appraisal discussion
- developing and agreeing a personal development plan with the appraisee
At its inception, the medical appraisal process was seen to be developmental and supportive. The process was seen as a formative, systematic and regular review of past achievements with constructive planning of future progress. It is now clear that appraisal is central to revalidation process. There is a requirement for the appraiser to assess and judge the adequacy of the information presented in the context of revalidation. These judgements raise the question: - what is the purpose of appraisal?
The medical workforce in the UK is highly trained, motivated and busy. The vast majority of doctors fulfil the requirements for revalidation with little extra work. Most of the information required for revalidation is gathered from the workplace, however some doctors may find it difficult to gather this information and present it in such a way that the requirements are met.
The GMC has published its Framework for Appraisal and Assessment based on four domains. Each of these four domains has three attributes. The medical Royal Colleges were asked to suggest standards and information that would map to these 12 attributes. As a result of the initial consultation, the GMC has decided that 6 strands of supporting information must be presented at least once during a five year revalidation cycle.
Domain 1 – Knowledge, Skills and Performance
- Maintain your professional performance
- Apply knowledge and experience to practice
- Keep clear accurate and legible records
Domain 2 – Safety and Quality
- Put into effect systems to protect patients and improve care
- Respond to risks to safety
- Protect patients and colleagues from any risk posed by your health
Domain 3 – Communication, Partnership and Teamwork
- Communicate effectively
- Work constructively with colleagues and delegate effectively
- Establish and maintain partnerships with patients
Domain 4 – Maintaining Trust
- Show respect for patients
- Treat patients and colleagues fairly and without discrimination
- Act with honesty and integrity
The six strands of supporting information
- Continuing professional development
- Quality improvement activity
- Significant events
- Feedback from colleagues
- Feedback from patients (where applicable)
- Review of complaints and compliments
This supporting information falls under four broad headings:-
- General information – providing context about what the doctor does in all aspects of their work
- Keeping up to date – maintaining and enhancing the quality of professional work
- Review of practice – evaluating the quality of professional work
- Feedback on practice – how others perceive the quality of the doctor’s professional work
In addition the individual is required to produce an annual PDP, reflect on their progress over the appraisal period and identify any constraints to that progress.
Personal Insights and reflections – Living PDP
Doctors are asked to:
- Review their own progress over the appraisal period
- Identify and describe any constraints that affected their service delivery or hindered their planned development
- Review their development over the appraisal period and begin defining perceived developmental needs for the next appraisal period using the living PDP
The Personal Development Plan (PDP) has been seen by many as a list of aspirations discussed and agreed at appraisal, which an individual can complete to a greater or lesser extent in the subsequent appraisal year. This approach may lead to an artificially created document from one meeting in a 12 month cycle of development. A PDP should be a fluid document owned by the individual and discussed at appraisal. In the context of revalidation there may be a greater emphasis placed on completion of PDP goals and as such the value and relevancy of the PDP to the individual takes on greater significance.
The living PDP allows the doctor to utilise:-
- The agreed PDP to plan development (agreed at previous appraisal)
- The additional PDP to add planned development in the current appraisal year
- The aspirational PDP to add items that they wish to consider for future years or to form the basis of discussion with the appraiser about next year’s PDP